Peripheral Rim-like Enhancement Research Articles

Ultrasound and CT findings of subcutaneous metastases in trunk and pelvis: a comprehensive analysis.

This study aimed to describe the ultrasound, CT findings, and clinical manifestations of pathologically confirmed metastases involving the subcutaneous fat layer of the trunk and pelvis. We included 30 patients with subcutaneous metastases in the trunk and pelvis, verified by ultrasound-guided biopsy. We comprehensively reviewed ultrasound findings of all 30 patients and contrast-enhanced CT findings of 25 patients obtained before biopsy. Medical records were reviewed, including primary malignancy type, presence of coexisting distant metastasis, and detection method leading to biopsy referral. Most subcutaneous metastases were heterogeneously hypoechoic (86.7%) with well-defined margins (80.0%), lobulated (46.7%) or round-to-oval (40.0%) shape, and vascularity (96.7%). Metastases frequently exhibited no contact (53.3%) or focal contact with deep peripheral fascia, resulting in acute contact angle formation (30.0%). Common CT manifestations included central low attenuation with peripheral rim-like enhancement (60.0%) or well-circumscribed lesion with heterogeneous enhancement (32.0%). Lung cancer (46.7%) was the prevalent primary malignancy. CT was the predominant detection method (56.7%). Coexisting subcutaneous metastases were present in 50.0% of cases, and distant metastases (less subcutaneous metastases) were observed in 90.0% of patients. This study describes typical imaging findings of subcutaneous metastases involving the trunk and pelvis. CT may play a crucial role in their early detection, and our results may assist radiologists in their diagnosis.

Porta Hepatis Tuberculous Lymphadenopathy: Clinical and Imaging Features of 10 Cases

Abstract Porta hepatis tuberculous lymphadenopathy (TL) is rare, and the clinical and imaging manifestations often mimic tumors. To offer a better understanding of porta hepatis TL and thus improve its diagnosis and treatment, here, we retrospectively reviewed and analyzed 10 porta hepatis TL cases between May 2017 and November 2022. In this study, porta hepatis TL occurred predominantly in women (70%), with a mean age of 43.1 years (range, 16–70 years). Among the patients, 60% were initially suspected of malignancy (metastatic lymphadenopathy and lymphoma). The clinical manifestations were nonspecific, such as fever and weight loss, without overt abdominal malaise. Many patients showed high concentrations of serum C-reactive protein, erythrocyte sedimentation rate, alkaline phosphatase, γ-glutamyl transpeptidase and carbohydrate antigen 125. Peripheral rim-like enhancement was a characteristic finding on contrast-enhanced CT for all the patients. Pathological examination confirmed the diagnosis in 90% of patients with caseous granulomatous inflammation and positive results of Xpert MTB/RIF, quantitative real-time PCR and/or metagenomic next-generation sequencing assays. All patients underwent antituberculosis therapy with a median treatment duration of 13.5 months (range, 1–43 months). They all showed satisfactory therapeutic responses with improved symptoms and resolution on imaging after treatment. Pathological examination by biopsy remains the primary diagnostic method. A combination of the characteristic epidemiologic, clinical, imaging features and lesion biopsy for histopathology are essential for the diagnosis and treatment of TL.

Preoperative differentiation of hepatocellular carcinoma with peripheral rim-like enhancement from intrahepatic mass-forming cholangiocarcinoma on contrast-enhanced MRI.

The present study aimed to determine the reliable imaging features to distinguish atypical hepatocellular carcinoma (HCC) with peripheral rim-like enhancement from intrahepatic mass-forming cholangiocarcinoma (IMCC) on contrast-enhanced magnetic resonance imaging (MRI). A total of 168 patients (130 male, 57.10 ± 10.53 years) pathological confirmed HCC or IMCC who underwent contrast-enhanced MRI between July 2019 and February 2022 were retrospectively included. Univariate and multivariate logistic regression analyses were used to determine independent differential factors for distinguishing HCC from IMCC, and the model was established. Bootstrap resampling 1000 times was used to verify the model, which was visualized by nomograms. The predictive performance of the model was evaluated based on discrimination, calibration, and clinical utility. Radiological capsule (OR 0.024, 95% CI: 0.006, 0.095, P<0.001), heterogeneous signal intensity (SI) on T1WI (OR 0.009, 95%CI: 0.001,0.056, P<0.001) were independent differential factors for predicting HCC over IMCC. A lobulated contour (OR 11.732, 95%CI: 2.928,47.007, P = 0.001), target sign on DP (OR 14.269, 95%CI: 2.849,82.106, P = 0.007), bile duct dilatation (OR 12.856, 95%CI: 2.013, P = 0.001) were independent differential factors for predicting IMCCs over HCCs. The independent differential factors constituted a model to distinguish atypical HCCs and IMCCs. The area under receiver operating characteristic (ROC) curve, sensitivity, and specificity values of the model were 0.964(0.940,0.987), 0.88, and 0.906, indicating that the model had an excellent differential diagnostic performance. The decision curve analysis (DCA) curve showed that the model obtained a better net clinical benefit. The present study identified reliable imaging features for distinguishing atypical HCCs with peripheral rim-like enhancement from IMCCs on contrast-enhanced MRI. Our findings may help radiologists provide clinicians with more accurate preoperative imaging diagnoses to select appropriate treatment options.

The diagnostic value of contrast-enhanced ultrasound for cervical tuberculous lymphadenitis.

OBJECTIVE:To investigate the value of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical tuberculous lymphadenitis (CTL).METHODS:The cohort study included 203 consecutive patients diagnosed with cervical lymph node. Before pathological or laboratory confirmation, all patients underwent CEUS examination, and the imaging findings were analyzed afterward. The diagnostic efficiency of the CEUS imaging findings of CTL was evaluated.RESULTS:Nighty-seven patients of the 203 (47.8%) were pathologically or laboratory confirmed with a CTL diagnosis while the remainder (52.2%) were diagnosed with non-tuberculous lymphadenitis. Regarding the imaging findings of CEUS, it was more common in CTL patients to find a pattern of heterogeneous enhancement inside the lymph nodes relative to non-tuberculous patients [81.44% (79/97) vs 15.09% (16/106), P < 0.01]. The sensitivity of the feature in diagnosis for CTL was 81.44% and the specificity was 84.91%, resepectively. Furthermore, a pattern of peripheral rim-like enhancement had been notable in CTL patients compared with non-tuberculous patients [86.60% (84/97) vs 12.26% (13/106), P < 0.01], associating with a diagnostic sensitivity of 86.60% and a specificity of 87.74%. When it came to the combination of both imaging findings mentioned above, the features were more prominent in CTL patients than compared with non-tuberculous patients [74.23% (72/97) vs 5.66% (6/106), P < 0.01], with a diagnostic sensitivity of 74.23% and a high specificity of 94.34%. Regarding area under curve (AUC) for the ROC analysis, the feature of internal heterogeneous enhancement, peripheral rim-like enhancement, and both features were 0.832, 0.872, and 0.843.CONCLUSIONS:CEUS patterns of heterogeneous enhancement and peripheral rim-like enhancement of lymph nodes are helpful characteristics for the diagnosis of CTL.

Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography

BackgroundTo summarize the characteristics of solitary necrotic nodules (SNN) in the liver observed under contrast-enhanced ultrasonography (CEUS).MethodsConventional ultrasonography (US) and CEUS were performed in 24 patients who were confirmed to have SNN by pathological assessment. The US data and dynamic enhancement patterns of CEUS were recorded and retrospectively analyzed.ResultsTen of 24 patients underwent surgical resection, while the other 14 patients underwent a puncture biopsy to be confirmed as SNN. Among the 24 patients, 13 patients had a single lesion and 11 patients had multiple lesions. The largest lesion was selected for CEUS examination for patients with multiple lesions. Eleven patients presented no enhancement in all three phases, while the other 13 patients presented with a peripheral thin rim-like enhancement in the arterial phase, an iso-enhancement in the portal phase and delayed phase. However, no enhancement in the interior of the lesions was detected during three phases of CEUS.ConclusionsSNN has characteristic findings on the CEUS, which play an important role in the differential diagnoses of liver focal lesions.

Contrast-enhanced ultrasound imaging features and clinical characteristics of combined hepatocellular cholangiocarcinoma: comparison with hepatocellular carcinoma and cholangiocarcinoma.

PurposeThe purpose of this study was to retrospectively compare the clinical characteristics and imaging features on (CEUS) of combined hepatocellular cholangiocarcinoma (CHC) with those of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).MethodsThe clinical information and CEUS features of 45 patients with CHC from 2015 to 2019 and 1-to-1-matched control subjects with HCC and CC (45 each) were compared.ResultsSimultaneous elevation of α-fetoprotein (AFP) and cancer antigen (CA) 19-9 was more common in CHC than in HCC and CC. In the arterial phase, hyperenhancement (homogeneous and heterogeneous) was more common in CHC (73.3%) and HCC (100%), while peripheral rim-like enhancement was more common in CC (55.6%). In the portal phase, marked washout was significantly more frequent in CHC and CC than in HCC (42.2% and 53.3% vs. 6.7%). In the delayed phase, marked washout was more common in CHC (82.2%) and CC (93.3%) than in HCC (40.0%). The washout time (WT) was much shorter in CHC and CC than in HCC (33.8±13.1 seconds and 30.1±11.6 seconds vs. 58.4±23.5 seconds). Using the combination of simultaneous elevation of AFP and CA 19-9 with marked washout in the delayed phase and a WT <38 seconds or arterial hyperenhancement to differentiate CHC from HCC or CC, the accuracy, sensitivity, and specificity were 74.4%, 93.3%, and 55.6% and 71.1%, 80.0%, and 62.2%, respectively.ConclusionAlthough some CEUS imaging features of CHC, HCC, and CC overlap, the combination of tumor markers and CEUS features can be helpful in differentiating CHC from HCC and CC.

Imaging features of combined hepatocellular–cholangiocarcinoma on contrast-enhanced ultrasound: correlation with clinicopathological findings

To evaluate the relationship between the imaging features of combined hepatocellular-cholangiocarcinoma (CHC) on contrast-enhanced ultrasound (CEUS) and clinicopathological findings. From August 2004 to August 2016, 40 patients (29 males, 11 females; mean age 52.8±11.2 years) with histopathologically proven CHC were investigated. The CEUS imaging features and clinicopathological findings of CHC were analysed and compared retrospectively. On CEUS, peripheral irregular rim-like enhancement, diffuse heterogeneous enhancement, and diffuse homogeneous enhancement was illustrated in 13 (32.5%), 21 (52.5%), and six (15%) lesions, respectively. Histopathological findings showed hepatocellular carcinoma (HCC) predominance and cholangiocarcinoma (CC) predominance throughout the tumour were illustrated in 21 (52.5%) and 19 (47.5%) cases, respectively. HCC-predominant CHCs displayed diffuse heterogeneous enhancement more frequently than peripheral irregular rim-like enhancement (p=0.005), whereas CC-predominant CHCs displayed peripheral irregular rim-like enhancement more frequently than diffuse heterogeneous enhancement and homogeneous enhancement (p=0.005 and p=0.01, respectively). CHCs >5 cm displayed diffuse heterogeneous enhancement more frequently than diffuse homogeneous enhancement, whereas CHCs ≤5 cm displayed diffuse homogeneous enhancement more frequently than diffuse heterogeneous enhancement (p=0.004). The enhancement pattern of CHC on CEUS depended on the relative proportionsof the HCC and CC components and showed size-dependent characteristics.

Imaging Features on Contrast-Enhanced Ultrasound and Clinical Characteristics of Hepatitis B Virus-Related Combined Hepatocellular–Cholangiocarcinoma: Comparison with Hepatitis B Virus-Related Hepatocellular Carcinoma

The objective of this study was to compare the clinical characteristics and imaging features on contrast-enhanced ultrasound (CEUS) of hepatitis B virus (HBV)-related combined hepatocellular–cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC). Thirty-one pathologically proven CHCs were included and 31 HCCs were randomly selected as controls. Elevated carbohydrate antigen (CA) 19-9 alone and simultaneous elevation of α-fetoprotein and CA19-9 were more frequent in CHC than in HCC patients (p = 0.004 and 0.029, respectively). On CEUS, homogeneous, heterogeneous and peripheral irregular rim-like enhancement was illustrated in 8 (25.8%), 12 (38.7%) and 11 (35.5%) CHCs and in 6 (19.4%), 23 (74.1%) and 2 (6.5%) HCCs, respectively (p = 0.007). Multivariate logistic regression analysis revealed CA19-9 elevation (p = 0.011, odds ratio [OR] = 6.545) and peripheral irregular rim-like enhancement on CEUS (p = 0.017, OR = 7.718) were independent variables. A receiver operating characteristic curve was plotted and the area under the curve was 0.740. CHC should be watched for in HBV-infected patients with liver tumor manifesting peripheral irregular rim-like enhancement on CEUS, accompanied by CA19-9 elevation.

Contrast-enhanced multiple-phase imaging features of intrahepatic mass-forming cholangiocarcinoma and hepatocellular carcinoma with cirrhosis: A comparative study.

The intrahepatic mass-forming cholangiocarcinoma (IMCC) is frequently misdiagnosed as hepatocellular carcinoma (HCC) in patients with cirrhosis, by numerous radiologists and clinical doctors, which results in the incorrect therapeutic treatment. A retrospective case-control study was conducted, and the contrast-enhanced multiple-phase (CEMP) computed tomography (CT) and magnetic resonance imaging (MRI) findings of 22 pathologically confirmed IMCC patients and 22 HCC controls with underlying liver cirrhosis were analyzed at the present hospital, from January 2010 to December 2015. In addition, serum tests were conducted and clinical symptoms of patients evaluated. A statistical analysis revealed that the enhancement pattern, signal on MRI delayed phase (P<0.001), maximum diameter, capsule retraction, portal vein invasion, bile duct dilation and abdominal lymphadenectasis characteristics were different between IMCC and HCC patients with cirrhosis. On CEMP CT and MRI analysis, the most frequently occurring enhancement patterns of IMCC were progressive patterns (P=0.001 or P<0.001). Conversely, the most frequently occurring enhancement patterns present in HCC were the washout patterns (P<0.001). Therefore, the diagnosis of IMCC in cirrhotic patients should be verified with CEMP CT and MRI analysis for the future, to determine presence or absence of progressive and/or peripheral rim-like enhancement, a hyperintensive delayed phase with capsule retraction, portal vein invasion, bile duct dilation, abdominal lymphadenectasis and increased levels of CA199.

Imaging features on contrast-enhanced ultrasound and pathological analysis of combined hepatocellular-cholangiocarcinoma

Objective To evaluate the correlation between the imaging features on contrast-enhanced ultrasound (CEUS) and pathological characteristics of combined hepatocellular-cholangiocarcinoma (CHC). Methods Forty patients with pathologically proven hepatic CHC were evaluated, the CEUS imaging findings and pathological characteristics of CHC were retrospectively analyzed. Results On CEUS, peripheral irregular rim-like enhancement, diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 13(32.5%), 21(52.5%) and 6(15.0%) lesions, respectively. Pathological findings showed that HCC-predominance, CC-predominant, and similar proportions of the two components were illustrated in 16(40.0%), 19(47.5%) and 5(12.5%) cases, respectively. The presence of necrosis were illustrated in 28(70.0%) cases. On CEUS, when the enhancement pattern was peripheral irregular rim-like enhancement, CC-predominance and necrosis were presented in 11(84.6%) and 10(76.9%) cases, respectively. When the enhancement pattern was diffuse heterogeneous enhancement, CC-predominance and necrosis were presented in 11(52.4%) and 18(85.7%) cases, respectively. When the enhancement pattern was diffuse homogeneous enhancement, HCC-predominance and necrosis were presented in 4(66.6%) and 0(0%) cases, respectively. There were significant differences in relative proportion of HCC, CC components and tumor necrosis among the three types of enhancement pattern on CEUS (P=0.009 and P 5 cm, peripheral irregular rim-like enhancement, diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 8, 18 and 1 cases, respectively. There were significant differences in the three types of enhancement pattern between lesion size of ≤5 cm and >5 cm on CEUS (P=0.006). Conclusions The imaging findings of CHC on CEUS depends on the relative proportions of HCC and CC component and on size-dependent patterns. Key words: Contrast-enhanced ultrasound; Liver neoplasms; Combined hepatocellular-cholangiocarcinoma

Intrahepatic mass-forming cholangiocarcinoma: enhancement pattern on Gd-BOPTA-MRI with emphasis of hepatobiliary phase.

To describe the Gd-BOPTA MRI findings of intrahepatic mass-forming type cholangiocarcinomas (IMCs), with emphasis on the hepatobiliary phase (HBP). We reviewed retrospectively 29 IMC patients who underwent Gd-BOPTA-MRI between June, 2004 and June, 2014. Images were acquired prior to, and after, administration of 15-20mL of Gd-BOPTA in the dynamic phase (arterial phase, portal venous phase, and 3-5min phase), 10-15-min late phase, and 2-3h HBP phase. In the dynamic phase, 27 (93%) lesions showed a peripheral rim-like enhancement in the arterial and portal venous phases, followed by progressive filling-in on the delayed images. In 14 (56%) cases, a hypointense peripheral rim was identified in the 10-15-min late phase, delineating a target pattern. In the HBP, the cholangiocarcinoma showed a diffuse, mainly central and inhomogeneous enhancement (cloud of enhancement) in 28 (96%) patients; in 23 (79%) cases, there was an association between cloud appearance and a hypointense peripheral rim, showing a target pattern. Gd-BOPTA MRI pattern of IMC on dynamic study is similar to that of conventional extracellular agents, that is peripheral enhancement with progressive and concentric filling of contrast material on delayed phases. At 10-15min delayed phases, IMC shows often a peripheral hypointense rim consistent with a target appearance. In the HBP, due to progressive central enhancement (cloud) and peripheral hypointense rim, an higher number of tumors show a target appearance; this pattern is not specific and would also be expected to be seen in metastases from adenocarcinoma.

Diagnostic value and characterization of contrast enhanced ultrasound for hepatic giant hemangionmas

Objective To explore the enhancement pattern and characterization of hepatic hemangionmas with contrast enhanced ultrasound (CEUS). Methods A total of 44 patients with 49 nodules preliminary diagnosed of liver hemangioma were included in this study. For each nodule, the enhancement pattern, level, and dynamic change of CEUS were evaluated, and the features of hemangionmas were groups as echoic and compared with those on CEUS. Results All hemangiomas enhanced in arterial phase with centripetal progression in venous and late phase on CEUS, among which 41 lesions showed peripheral nodular enhancement while 8 showed peripheral rim-like enhancement. The whole-tumor enhancement pattern was seen in 13 lesions and part-tumor enhancement was shown in 36 lesions. The performance of part-tumor was independent of tumor echoic and hypoechoic tumors mostly presented to be whole-tumor enhancement pattern. During portal venous and late phase, 42 lesions showed hyperenhancement, while 7 lesions showed isoenhancement. Conclusions CEUS can suggest the enhancement dynamic characters of hepatic giant hemangionmas and reveals the relationship of grey-scale echoic and enhancement pattern of hemangiomas. It is important to diagnosethe hepatic giant hemangionmas for CEUS. Key words: Ultrasonography; Microbubbles; Liver neoplasms; Hemangioma

Contrast-Enhanced Ultrasound for the Characterization of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma

Purpose and methods: The ability of contrast-enhanced ultrasound (CEUS) to differentiate between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is still controversial. We reviewed the CEUS imaging of 819 patients (HCC=546, ICC=273) with an established pathological diagnosis. The enhancement patterns of lesions and the diagnostic performance of CEUS were analyzed. Results: Arterial hyperenhancement followed by washout was observed in 92.3% (504/546) of the HCC lesions and 85.7% (234/273) of the ICC lesions on CEUS (p<0.05). Additionally, the ICCs presented contrast washout much earlier than the HCCs, with an average time of 27.5 seconds after injecting the contrast agent compared with 70.1 seconds for the HCCs (p<0.05). Peripheral rim-like enhancement was observed in 68.5% (187/273) of the ICCs, which was significantly more common than that in the HCCs (2.0%, 11/546) (p<0.05). When using arterial hyperenhancement with a washout phase later than 43 seconds after injecting the contrast agent and with no peripheral rim-like enhancement as the diagnostic criteria for HCC ≤5 cm in diameter, the area under the curve was 0.808, with 64.1% sensitivity, 97.4% specificity and 73.6% accuracy. Conclusions: Although ICC may show the typical enhancement pattern of HCC on CEUS, peripheral rim-like enhancement and quick contrast washout show high efficiency in the differentiation of HCC from ICC.

Early treatment response to sorafenib for rabbit VX2 orthotic liver tumors: evaluation by quantitative contrast-enhanced ultrasound.

The aim of our study was to investigate the application of contrast-enhanced ultrasound (CEUS) and its quantification analysis for the prediction of early treatment response of sorafenib on rabbit VX2 liver tumor model. Rabbits were implanted VX2 tumor mass to establish a liver tumor model. Fourteen days after tumor implantation, rabbits presented with single liver tumor were randomly divided into two groups. Rabbits in treatment group were given by gavage once a day for 14 days with sorafenib suspension at a dose of 30 mg/kg, whereas rabbits in control group were given saline by gavage of the same volume. CEUS was performed before treatment and 3, 7, 14 days after treatment for the analysis of tumor size, enhancement pattern, and necrosis range. The time intensity curve (TIC) was used to obtain quantitative parameters of enhancement patterns. Before sorafenib administration, tumor volumes ranged from 0.24 to 0.75 cm(3) (mean 0.49 ± 0.18 cm(3)) in treatment group and 0.24 to 0.44 cm(3) (mean 0.30 ± 0.12 cm(3)) in control group. The dynamic enhancement patterns of tumors were homogeneous hyper-enhancement (n = 8), heterogeneous hyper-enhancement (n = 4), and peripheral rim-like enhancement (n = 2). All tumors of the treatment group presented with peripheral rim-like enhancement with large necrotic area after sorafenib administration, whereas tumors of the control group showed heterogeneous hyper-enhancement (n = 5) and peripheral rim-like enhancement (n = 2). There was a significant difference in area under the curve (AUC) before and after sorafenib treatment (P = 0.045). CEUS may be of value in the evaluation of early therapeutic response after sorafenib administration.

The analysis of enhancement pattern of hepatic inflammatory pseudotumor on contrast-enhanced ultrasound

The aim of this study was to assess the role of contrast-enhanced ultrasound (CEUS) in the characterization of hepatic inflammatory pseudotumor (IPT). We retrospectively reviewed 36 cases of histopathologically diagnosed IPT. Nodule enhancement appearances during the arterial, portal, and delayed phases were defined as hyperenhancement, isoenhancement, hypoenhancement, and non-enhancement compared with the surrounding liver parenchyma. Statistical analysis was performed by the one-way ANOVA and χ (2) tests. Among total 36 cases, 7 nodules were absent of contrast enhancement during all three phrases on CEUS. Twenty-nine nodules appeared different forms of enhancement in arterial phase. Diffuse homogeneous hyperenhancement, diffuse heterogeneous hyperenhancement, peripheral rim-like enhancement, and diffuse iso-enhancement were found in 10, 12, 5, and 2 of the nodules, respectively. Twenty-five nodules showed hypoenhancement in portal and delayed phases. Four nodules showed contrast washed out synchronously with normal liver parenchyma. The median time to enhancement, median time to peak, and median time to wash out of the nodules were 17s (range 11-28s), 23s (range 14-42s), and 45s (range 23-100s), respectively. No statistical significant differences were found in the above parameters of nodule enhancement and proportion of enhancement patterns when dividing the nodules into subgroups by nodule size. IPT displays a variety of enhancement patterns due to pathological changes in the course of disease progression. Some characteristics on CEUS may be helpful in the differential diagnosis of IPT.

Clinical Features, Image Findings, and Prognosis of Inflammatory Pseudotumor of the Liver: A Multicenter Experience of 45 Cases

Background/AimsInflammatory pseudotumor (IPT) of the liver is a rare disease characterized by chronic infiltration of inflammatory cells. However, the clinical characteristics and outcomes of IPT remain uncertain.MethodsClinical features, image findings, and outcomes of 55 patients with histologically proven IPT were evaluated.ResultsThey consisted of 26 men and 19 women with median age of 65 years. Serum carcinoembryonal antigen and carbohydrate antigen 19-9 levels were normal in 42 patients (93.3%). Enhanced CT scans indicated poorly defined peripheral enhancement (82.5%) at the arterial phase and poorly defined hyperattenuating lesions with internal hypoattenuating areas at the equilibrium phase (77.0%). Gadolinium-enhancement MRI revealed poorly defined peripheral rim-like enhancement (77.8%). Ten patients underwent surgical resection and 35 were treated conservatively with or without antibiotics. No recurrence was noted after surgical resection during follow-up (1 to 48 months). In all patients who received conservative treatment, complete resolution or size reduction was noted during follow-up (1 to 192 months).ConclusionsCT and MRI provide clues to the diagnosis of IPT in patients with liver masses and normal tumor markers. However, due to the lack of pathognomonic findings, the clinician's suspicion and histological diagnosis are necessary to make an accurate diagnosis of IPT.

Neoplasm-like abdominal nonhematogenous disseminated tuberculous lymphadenopathy: CT evaluation of 12 cases and literature review

To assess the diagnostic value of computed tomography (CT) imaging in screening for abdominal nonhematogenous disseminated tuberculous lymphadenopathy (TL). The CT scans of 12 patients with abdominal nonhematogenous disseminated TL suggestive of neoplasm were retrospectively analyzed in this review. The final diagnoses were confirmed by lymph node pathology for seven patients and by laparoscopic surgery for five patients. All of the patients were treated at our institution between April 1995 and August 2009. The sites of involvement were the periportal (n = 6), peripancreatic (n = 3), periaortic (n = 3), and mesenteric (n = 2) regions. On the plain CT scan, the lymphadenopathy showed a heterogeneous isodensity or hypodensity in 11 patients and a low density in one patient. Peripheral enhancement was observed on the dynamic contrast-enhanced CT scans for all patients. In two cases, scans were more revealing during the portal venous and delayed phases. Abdominal lymphadenopathy with predominant peripheral rim-like enhancement on the dynamic contrast-enhanced CT scan may suggest a diagnosis of TL.

Brunner's Gland Hamartoma

To describe the computed tomographic (CT) features of Brunner's gland hamartoma with histopathologic correlation. The CT images of 9 patients with pathologically proven Brunner's gland hamartoma were reviewed retrospectively. All patients underwent CT performed on multidetector-row CT scanner with various protocols, all of which included portal venous phase. Brunner's gland hamartomas presented as small (mean, 1.9 cm) Yamada type II or III (67%, 6/9) polyps with frequent internal cyst (33%, 3/9). They were isoattenuated on unenhanced CT (83%, 5/6) and hypoattenuated in portal phase (56%, 5/9) when compared with the pancreas. Peripheral rimlike enhancement in earlier phase was commonly found (67%, 6/9) and most of them enhanced homogeneously in the later phase (100%, 4/4). In a patient with asymptomatic small submucosal mass in the duodenal first or second portion, hypoattenuated mass with peripheral rimlike enhancement or internal cystic change suggests the possibility of Brunner's gland hamartoma.

Dynamic Evolutionary Changes in Blood Flow Measured by MDCT in a Hepatic VX2 Tumor Implant over an Extended 28-day Growth Period: Time-Density Curve Analysis

The enhancement pattern of malignant tumors has been studied in short-term animal models (7-14 days), but the reported results have been variable and inconsistent. The purpose of this study was to investigate the changing blood flow characteristics of VX2 tumors implanted in rabbit livers with contrast-enhanced multidetector computed tomography (MDCT) to establish a predictable pattern of vascular evolution over an extended 28-day growth period. VX2 carcinoma was implanted in livers of 10 male New Zealand White rabbits. Dynamic CT (2/seconds x 60 seconds) was conducted on days 7, 14, 21, and 28 after tumor implantation. Enhancement parameters of time-density curve (TDC), time to start (T0), time to peak (TP), maximum enhancement (DeltaH), slope of enhancement (SLe), and washout (SLw) in tumor center, tumor rim, and normal liver were analyzed. Tumor samples corresponding to CT images of one tumor on days 14 and 21 and seven tumors on day 28 were stained with hematoxylin and eosin and anti-CD31 monoclonal antibody. The relationship between enhancement parameters and histology parameters (thickness of tumor border, extent of blood stasis, and luminar vessel density) was analyzed. Consistent growth, appearance, and vascular changes occurred in 7 of 10 animals over the 4-week observation period. Peripheral rim-like enhancement was noted in CT images. TDC analysis showed that tumor rim enhancement was pronounced and more rapid than normal liver initially but this difference diminished with tumor progression. The SLe, SLw, and DeltaH decreased from 10.03 +/- 3.25 Hu/second, 0.42 +/- 0.25 Hu/sec, and 58.00 +/- 25.27 Hu on day 7 to 5.86 +/- 2.73 Hu/second, 0.10 +/- 0.13 Hu/second, and 37.78 +/- 8.89 Hu/second on day 28, respectively. TP increased from 12.71 +/- 4.85 seconds on day 7 to 25.57 +/- 7.75 seconds on day 28. No significant changes were noted on the TDC parameters in normal liver. The maximum density difference between tumor rim and normal liver (D(rim-liver)) appeared 10.5 +/- 2.1 seconds after contrast injection. The maximum D(rim-liver) decreased from 54.33 +/- 37.86 Hu on day 7 to 11.16 +/- 13.03 Hu on day 28. On histological analysis, viable tumor cells were found in tumor rim with few luminar vessels. The tumor border showed desmoplastic reaction, vascular dilation and proliferation, inflammatory cell infiltration, and blood stasis. These findings were more obvious on day 28 than those on day 14. TP showed significant positive correlations with the extent of blood stasis in tumor border and adjacent liver and the maximum thickness of the tumor border (r = 0.945 and 0.893 respectively, P < .05). The rabbit VX2 liver tumor is a hypovascular tumor with perilesional enhancement over its lifespan as imaged by MDCT. Consistent changes in the measured vascular parameters correlated with the size/age of the tumor implants. These findings suggest that the accuracy of CT enhancement imaging for VX2 liver tumor detection might be decreased with tumor development.

Thoracic textilomas after myocardial revascularisation: typical CT findings

The objective of this work was to report the tomographic findings in five cases of intrathoracic textilomas. The CT scans of five patients presenting with textilomas after being submitted to thoracotomy for myocardial revascularisation were reviewed retrospectively. Two chest radiologists studied the scans independently, and decisions concerning the CT findings were made by consensus. In each of the five cases, the imaging findings were similar and showed lesions resembling an extrapulmonary mass and well-defined contours situated at the marginal posterior pleural surface. In four of the five cases, a low-density centre and peripheral rim-like enhancement were observed after administration of contrast media. The suspicion of textiloma should be raised when a patient with a history of previous myocardial revascularisation surgery presents with an extrapulmonary mass in close contact with the posterior pleural surface.